<div id="slide1">
	<form action="" method="post" id="khach_hang_form">
		<fieldset>
			
			<div class="form-group">
                name:
				<input type="text" id="name" name="name">
			</div>
            <div class="form-group">
                phone:
				<input type="text" id="phone" name="phone">
			</div>
            <div class="form-group">
                email:
				<input type="text" id="email" name="email">
			</div>
            <?php
                //print_r($results);
            ?>
            <div class="form-group">
                shop:
				<select id="shop_id" name="shop_id">
                    <?php
                        foreach($results['shop'] as $v):
                    ?>
                        <option value="<?=$v->id?>"><?=$v->name?></option>
                    <?php
                        endforeach;
                    ?>
                </select>
			</div>
            location:
            <input type="text" name="ip" id="ip" />
            <input type="text" name="country" id="country" />
            <input type="text" name="city" id="city" />
            <input type="text" name="location" id="location" />
            <input type="text" name="lat" id="lat" />
            <input type="text" name="lon" id="lon" />
            
            
			<input type="submit" value="Login" class="btn btn-lg btn-primary btn-block">
		</fieldset>
	</form>
</div>
<!--end slide1-->